Q: I am 57 and was diagnosed with prostate cancer last year. I had surgery 11 months ago and my doctor said I am cancer free. I have not been able to have an erection since my surgery. I tried Viagra and Levitra, but because of the side effects I stopped taking them. I tried herbal remedies, but they’re not working. So you have any suggestions?

A: Your question is one of the most common letters/emails that I receive. Unfortunately prostate cancer and the subsequent treatments can dramatically affect an erection. Part of the reason is the underlying effect of the cancer on the prostate. In addition, current treatments with surgery, radiation therapy, and hormones can all impair blood flow to your penis and also the nerves that supply the sensations to the penis that help produce a good erection. Expectations of sexual performance after treatment can best be predicted by how healthy your erections were before the cancer was diagnosed. Clearly this is influenced by your age and other risk factors such as diabetes, high blood pressure, and heart disease.

Just as you did, nearly all men will treat their prostate cancer and deal with the consequences after recovery. Some men might want to wait weeks or months before resuming sexual activity. The quality of your erection is likely to improve significantly during the recovery period. If your new level of erection is inadequate for you or your partner, then the first step would be Viagra, Levitra, or Cialis. But don’t give up if these don’t work or if your are experiencing intolerable side effects. Other options include the use of a vacuum erection device, which is a very easy technique with a high success rate and minimal side effects. Trained urologists can also teach patients how to safely utilize a penile injection technique that can often produce excellent erections. And if all else fails, many men will turn to penile implant surgery. This is especially true for younger men such as yourself.

There is no harm in beginning treatments for erectile dysfunction (ED) as soon as you are physically and psychologically ready. In fact, there is good medical data showing that the earlier the man resumes sex and the sooner he begins treatment for ED, the more likely he is to get a more full recovery of his erections. So don’t be shy to tell your physician that you are ready to resume intimacy.